Financial and Insurance Information

The cost of the operation includes hospital fees, surgeon fees, anesthesia fees, lab and x-ray fees and a number of miscellaneous fees. Many insurance companies will cover the full cost of bariatric surgery. They do require that we provide them with documentation that your surgery is medically necessary due to specific health issues related to obesity. Often you will be asked to provide documentation of your attempt and failures at other non-surgical weight loss methods, nutritional counseling, and that you do not have major psychiatric or emotional problems that would make surgery unsafe. Your surgeon’s clinic staff will be able to help you meet insurance company documentation requirements.

If you have an insurance policy that specifically says it excludes payment for bariatric surgery, there are other options. Many patients choose to pay for the operation themselves. We are happy to help you explore payment options.
Here are some key steps to obtaining insurance coverage for weight loss surgery:

• Read and understand the “certificate of coverage” that your insurance company is required by law to give you. If you do not have one, ask your company’s benefits administrator or ask your insurance company directly.
• You might be required by your policy to obtain a referral from your primary care physician. Even if you are not required to get a referral, it is a good idea to have the support of your primary care physician.
• Document every visit you make to a health care professional for obesity-related issues, and visits you make to supervised weight loss programs. Also document other weight loss attempts made through diet centers and fitness club memberships. Keep good records, including receipts.
• If your bariatric surgeon recommends weight loss surgery, he/she will contact your insurance company for pre-authorization.
  

One month is the usual time for an insurance provider to respond to your request. If you have not heard from your insurance company after one month, you should call them to check on the status of your request. Even if your initial request is denied, there are still options available through an appeal process that insurance companies provide. It is important that you reply to a denial quickly. It is important that you clearly understand the appeal rules of your insurance plan. The clinical staff will be able to help you with the appeals process.